Thyroid Disease: Misunderstood and Underdiagnosed

The thyroid is a delightfully complex organ situated in the front of the neck. It is very sensitive to subtle imbalances that can occur in the body at large. Thyroid disease and/or dysfunction is often under diagnosed and insufficiently managed, and can go undetected for years, either because there are no symptoms until the disease has progressed significantly, or because initial blood screening tests have shortcomings. For those who are diagnosed with a thyroid disease there is much that can be done to restore or at least improve thyroid functioning once the cause of the problem has been identified.

About the Thyroid. Normal levels of thyroid hormones are essential for the harmonious functioning of the body. These hormones set your metabolic rate and affect tissue growth, sexual and menstrual function, bone metabolism and more. To get a sense of how important they are here is a list of some of the side affects of an under functioning thyroid (or, hypothyroid): fatigue, feeling cold, weight gain, dry skin, constipation, poor concentration and memory, depression, menstrual irregularity and hair loss. An overactive thyroid (or, hyperthyroid) in contrast will have symptoms such as sweating, nervousness, heart palpitations and weight loss.

How it Works. The thyroid gland is stimulated by a hormone called Thyroid Stimulating Hormone (TSH) from a gland called the pituitary gland; TSH prompts a healthy thyroid gland to produce Thyroxine (T4). As T4 levels rise they cause the pituitary gland to reduce its production of TSH, in a feedback loop, in order to keep T4 levels in check. In contrast, if T4 levels are too low, then there is less feedback, and TSH levels rise to stimulate the thyroid to produce more T4. TSH is what is used to initially screen for thyroid problems in blood tests.

In addition to its role in the feedback loop, T4 is converted to triiodothyronine (T3). T3 is the ACTIVE form of thyroid hormone. T3 is primarily responsible for all the affects the thyroid has on our tissues. Keep this in mind as you read on!

Lab Tests Reliability Questioned. One reason thyroid disease may go undiagnosed is that the normal laboratory ranges for TSH are outdated; they do not reflect the recommendations of the American Association of Clinical Endocrinologists for the normal TSH lab range to be 0.3-3.1. Toronto labs use a reference range of 0.3-5.6. Based on their experience, other medical professionals such as Dr. Brota Barnes, MD and Dr. Alan Gaby MD, recommend an even smaller range of 0.3-2. In my practice, if someone has TSH levels above 2, and has signs and symptoms of thyroid disease, I investigate further.(1) This can include a more comprehensive panel of blood tests including TSH, T4, T3 and thyroid antibodies.

Poor Conversion of T4 to T3. In conventional medicine, if TSH levels are ‘normal’ on an initial screen, no further investigations are done. However, normal TSH levels do not always equal normal thyroid functioning because TSH levels are mostly a reflection of T4 levels (involved in the feedback loop) and not T3 levels, the more active form. Simply put, you may have normal T4 levels but cannot convert T4 to T3 efficiently. This problem cannot be picked up by a simple TSH screen. For those diagnosed with a hypothyroid condition, the standard medication Synthroid only supplies T4. This can explain why some people still have symptoms of an under-active thyroid while on the medication: they do not convert T4 to the active T3 very efficiently. T4 to T3 conversion can be negatively impacted by high cortisol levels (our stress hormone), excessive estrogen (for example, from hormone replacement therapies), and by nutrient deficiencies including selenium, vitamins D, B2, B6 and B12. Zinc also plays a role though poorly understood. These excesses and deficiencies are quite common in my experience.

Tissue or Cellular Hypothyroidism. Doctors can at times be dismissive of the complaints of their patients with normal thyroid hormones levels when they are on thyroid medications. Research reveals that even with normal T3 and T4 levels there is at least one other potential issue; in order for T3 to be affective it must be taken up by the cells of all our tissues and organs. Growing evidence suggests that some people may have cells that are resistant to the uptake of T3.(2) The reasons are poorly understood. One hypothesis is that T3 is competing for binding sites on cells that are occupied by other hormones which are in surplus.

The Iodine Story. Did you know that iodine is one of the building blocks of your T4 hormone ? Iodine used to be a core treatment for thyroid disease in mainstream medicine, but this practice has fallen out of use based on misunderstandings such as the assumption that iodized salt has rendered it irrelevant. Despite the widespread use of iodized salt, chemicals we are exposed to through our water supply and elsewhere can compete in the body with iodine; namely fluoride, bromine and chlorine. Dr. David Brownstein, MD., author of “Iodine: Why You Need It; Why You Can’t Live Without It“, claims that iodine deficiencies are still widespread. Suffice is to say I have found iodine an extremely beneficial treatment for thyroid as well as other diseases provided deficiencies are properly diagnosed using specialized urine tests and that it is prescribed under strict supervision.(3)

Toxins and the Thyroid. The thyroid is an extremely sensitive organ, affected not only by emotional stress, but also chemical stresses such as caffeine, nicotine, alcohol and environmental toxins such as polychlorinated biphenyls (PCBs), lead and cadmium. While toxicity is a huge topic, the point to be made here is that detoxification as well as lifestyle modifications may play an important role in normalizing thyroid functioning.(4-5)

For those diagnosed with hypothyroidism and/or hyperthyroidism there is much to be explored and many approaches to improving thyroid function, beyond simply taking T4 replacement. Thyroid conditions are frequently autoimmune, such as is the case with Hashimoto’s Thyroiditis and/or Grave’s Disease, and therefore immune regulation should be explored as part of the treatment approach. Many possibilities can be explored including underlying viral and or bacterial infections, nutritional deficiencies, elevated cortisol levels (our stress hormone that suppresses the immune system), heavy metal toxicities and more. Each and every case is unique.

Laboratory Testing for Thyroid Disease. If someone has signs and symptoms of an under functioning thyroid, despite normal TSH levels, a series of basal body temperature tests are a valuable diagnostic tool. Since the TSH test alone clearly cannot rule out thyroid imbalance, screening for suspected thyroid problems should at least include TSH, T4 and T3 if not thyroid antibodies as well. For those wanting to treat the root cause of their thyroid disease in order to possibly wean off medications, a thorough workup is needed including relevant sex hormones, vitamins, iodine, heavy metals and more.

Naturopathic Approach to Thyroid Disease. Treating the thyroid requires a thorough and methodical approach starting with diagnostic tests to identify the root cause or causes. The treatment goals will be determined by the diagnostic findings and may include any of the following: detoxification, vitamin and mineral supplementation, sex hormone balancing, adrenal gland support (to lower cortisol), supervised high dose iodine therapy, immune modulation, lifestyle modification (for example, removing sources of chlorine and fluorine) and dietary modification. The thyroid is only a product of the complex web in which it resides and therefore the rebalancing required to normalize the thyroid would in turn bring balance to the entire body.